Effects of increasing compliance with minimal sedation on duration of mechanical ventilation: a quality improvement intervention.

Critical Care : the Official Journal of the Critical Care Forum
A C K B AmaralAngie Jeffs

Abstract

In the past two decades, healthcare adopted industrial strategies for process measurement and control. In the industry model, care is taken to avoid minimal deviations from a standard. In healthcare there is scarce data to support that a similar strategy can lead to better outcomes. Briefly, when compliance is high, further attempts to improve uptake of a process are seldom made. Our intensive care unit (ICU) improved the compliance with minimizing sedation from a high baseline of 80.4% (95% CI: 66.9 to 90.2) to 96.2% (95% CI: 95.2 to 97.0) 12 months after a quality improvement initiative. We sought to measure whether this minute improvement in compliance led to a reduction in duration of mechanical ventilation. We collected data on compliance with the process during 12 months. A trained data collector abstracted data from charts every other day. Our database contains data for length of mechanical ventilation, mortality, type of admission, and acute physiology and chronic health evaluation (APACHE) II scores for the 12 months before and after the process improvement. We included 1556 patients. There was an immediate effect of the intervention (regression coefficient = -0.129, P value < 0.001) and the secular trend was a determi...Continue Reading

Citations

Nov 26, 2013·Critical Care : the Official Journal of the Critical Care Forum·Ewan C GoligherArthur S Slutsky
Feb 11, 2015·The Science of the Total Environment·Karin SteffensJulien Moeys
Dec 6, 2014·Critical Care : the Official Journal of the Critical Care Forum·Barbara SneyersAnne Spinewine
Feb 13, 2015·Critical Care : the Official Journal of the Critical Care Forum·Otavio T RanzaniUNKNOWN AMIL Critical Care Group

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BETA
sedation

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STATA
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